张嗣兰辨治脱疽经验

ZHANG Silan's Experience in Syndrome Differentiation and Treatment of Gangrene

脱疽病因病机复杂,病程较长,致残率高。张嗣兰教授提出了“解毒破瘀并重,调气扶正并行”的重要理论,认为气机阻滞、血脉瘀阻、肢节失养是其基本病机,将其分为寒湿凝滞证、湿热毒盛证、气血亏虚证、血脉瘀阻证4种中医证型。临证时根据不同分型及临床表现采用不同治疗方法,以化瘀通络贯穿始终,辅以温阳、益气、补血、清热解毒之法,同时重视局部外治法。形成了内外同治、整体辨证与局部外治相结合的临床思辨特点。

The etiology and pathogenesis of gangrene are complicated,the course of disease is long,and it has a high disability rate.Professor ZHANG Silan puts forward an important theory of “focusing on both relieving toxin and removing blood stasis,and regulating qi and strengthening the body”.She believes that the basic pathogenesis of the disease is qi-block,blood-stasis,and limb-dystrophy,which is divided into four types of cold and dampness stagnation syndrome,dampness-heat toxicity excess syndrome,qi and blood deficiency syndrome,blood stasis syndrome.According to different syndrome types and clinical manifestations,different treatment principles are adopted to remove blood stasis and dredge collaterals,which is supplemented by methods of warming yang,supplementing qi,replenishing blood,clearing heat and detoxifying,in addition to paying attention to local external treatment.It has formed the clinical thinking characteristic of the combination of internal and external treatment,and combining overall syndrome differentiation and local external treatment.